Who can prescribe Suboxone?
Any doctor with a standard Drug Enforcement Administration (DEA) registration can prescribe Suboxone. So can a physician assistant (PA) or a nurse practitioner (NP), where state law allows. There is no longer a special federal waiver, and there is no federal limit on how many patients one prescriber may treat.
Suboxone is a film that dissolves under the tongue, and it contains buprenorphine and naloxone. When I say Suboxone here, I mean all of the buprenorphine medications used to treat opioid dependence, including ZubSolv and the generic films and tablets.
I first wrote this article in 2016, when the answer was a short list of doctors who held a special certificate. The law has changed since then. The problem has not.
So, if nearly every prescriber in the country is now allowed to write for Suboxone, why is it still so hard to find one who will? And, once you find one, how do you know that you have found the right doctor?
What happened to the X-waiver and the patient limits?
For more than twenty years, a doctor who wanted to prescribe buprenorphine for opioid dependence had to complete an eight-hour course and apply for a special DEA number that began with the letter X. That doctor could then treat 30 patients at a time, then 100, and eventually 275.
Did a doctor ever need a waiver to prescribe oxycodone? No. A doctor needed special permission to treat opioid addiction, and none at all to prescribe the opioids.
Congress eliminated the X-waiver in the Consolidated Appropriations Act, 2023, which was signed on December 29, 2022. Today, any prescriber whose DEA registration covers Schedule III medications, the category that includes buprenorphine, may prescribe it for opioid dependence. There are no longer any federal limits on the number of patients a prescriber may treat with buprenorphine.
One requirement remains, and it applies to everyone. Since June 27, 2023, every prescriber who applies for or renews a DEA registration, other than a veterinarian, must attest one time to eight hours of training in treating opioid and other substance use disorders.
So, what kind of doctor can prescribe Suboxone? A family doctor can, and so can an internist, an emergency physician, an obstetrician, or a psychiatrist. State law decides what a PA or an NP may prescribe. You do not need a specialist.
Any DEA-registered prescriber can. So, why won’t more of them?
Being allowed to prescribe is not the same as prescribing. An analogy that might help is the driver’s license.
Every licensed driver in America is allowed to drive a car with a stick shift. The license covers it, and no one at the Department of Motor Vehicles asks whether you know how. Yet, most of us would stall at the first stop sign, and many of us would refuse to get in the car at all.
While this is not a perfect analogy, the same is now true of buprenorphine. The DEA registration covers it, and the willingness is another matter. So, do not ask whether a doctor can prescribe Suboxone. Ask whether the doctor does.
When I wrote the first version of this article, many of the doctors listed in the directories had taken the course and then decided not to prescribe. A registration tells you even less than a certificate did. It does not tell you whether the doctor has ever written the prescription.
Why? In my opinion, the barrier was never only the paperwork. It is a lack of understanding of the patients, and it is attitude.
The patient these doctors picture is not the patient who shows up.
Many doctors imagine their waiting rooms flooded with people who use drugs, and they feel distaste. They may assume dishonesty before the patient has said a word.
So, who actually shows up? It could be the doctor’s next door neighbor, their child’s school teacher, a colleague, or a member of their own family. Some of these patients were first given an opioid by a doctor, for pain.
Opioid addiction can affect some of the most intelligent, creative, and productive people you will ever meet. They are human beings with a medical condition, and they have had the courage to ask for help.
Opioid use disorder is a medical condition, and the behavior is a symptom.
Opioid use disorder is the medical name for opioid addiction. It is a medical condition that requires medical treatment, and it is not something that a person can simply snap out of.
Physical dependence is not addiction, though with opioids the two often arrive together. Where addiction is present, the behavior that offends the doctor is a symptom. With treatment, the patient gets better.
Is the hesitation understandable? Of course. Working in a busy medical office can be overwhelming, and these patients may need more time than a short visit allows. Still, I hope that more doctors can put these feelings aside. Empathy can be learned, the same way we learn every other skill in medicine.
What does it cost when a doctor says no?
Imagine working up to a phone call for months, finally making it, and being told that the doctor does not treat “that kind of patient.” When a doctor declines to prescribe, the patient does not stop taking opioids. The patient goes back to the street.
The pain pills sold on the street today look like they came from a pharmacy, but they are counterfeit tablets pressed with fentanyl. Street heroin is commonly cut with fentanyl as well. A person in withdrawal will take them anyway, because withdrawal is that hard to bear.
Doctors have a tool that can help to prevent this. Many lives are on the line, and declining to use that tool is a choice.
Where do you find a doctor who actually prescribes?
Start with your own family doctor, or with the federal locator, FindTreatment.gov. A listing is a reasonable place to begin.
Unfortunately, a directory tells you who is listed. It does not tell you who will answer the phone. Call the office and ask plainly whether the doctor is accepting new buprenorphine patients, and how soon you can be seen.
Access is also uneven. Some parts of the country have few doctors who are willing to prescribe, and a person in a small town may be hours from the nearest one.
Is a Suboxone doctor by telemedicine a legitimate option?
Yes. For a person who lives far from a willing prescriber, a Suboxone doctor by telemedicine may be the only practical choice, and it is a legitimate one.
Under federal telemedicine rules administered by the DEA, a registered prescriber may start a patient on buprenorphine by video, or even by telephone, without an in-person examination first. Those temporary rules have been extended four times, and the current extension runs through December 31, 2026.
The DEA also published a separate rule in January of 2025, written specifically for buprenorphine by telemedicine, and it is now in effect. I cannot tell you what the rules will look like in 2027. Since they have changed more than once, and state law applies as well, ask the doctor what applies to you today.
While telemedicine helps, it is only part of the answer. You still need a pharmacy that will fill the prescription, and a doctor who is licensed where you live.
What should you ask before the first appointment?
As you can see, a doctor who is willing to write the prescription is only the beginning. It is not a bad idea to ask some questions before you schedule.
How much will a month of treatment cost? Can you reach the doctor at night? Who will deal with your insurance company? You should have the answers before the first visit, not after it.
First, ask what a month of treatment will cost.
Many Suboxone doctors do not accept insurance for the visits. While there is nothing wrong with that, you should know it before you walk in. It does not mean that your insurance will not cover the medication, and you may be able to file a claim yourself for reimbursement of the visit.
Some doctors charge one fee that covers the month. Others charge every time you walk in the door, even when they are the ones who scheduled you to come in every week. Ask whether urine drug screens and extra visits cost more.
You should be able to get a straightforward answer about the monthly cost. If the answer is very complex, you may want to call the next doctor on your list.
Second, ask how you reach the doctor after hours.
Treating opioid dependence is different from treating most other medical conditions. Especially in the first days, you may need to speak to the doctor during the day or in the evening, not at next month’s visit.
While a front desk can schedule your next appointment, it cannot tell you what to do when you feel sick at nine at night. If you get the sense that the doctor is protected by staff and never speaks to patients outside of a brief office visit, you may want to look elsewhere.
Third, ask who handles prior authorizations.
A prior authorization is a process in which the doctor must make the case to your insurance company before it will agree to pay for the medication. It can be time consuming, and there are doctors who refuse to get involved with it at all.
That refusal can cost you a great deal of money at the pharmacy. So, ask whether the doctor or the staff handles prior authorizations, and how quickly. Fortunately, the medication itself is usually covered by insurance, and there are now generic films and tablets that cost far less than the brand.
Fourth, if you have Medicare, ask whether the doctor participates or has opted out.
There are doctors who do not participate with Medicare in any form. A doctor who has opted out sees Medicare patients under a private contract, and Medicare does not pay for those visits.
The medication is a separate question. Call your Part D plan, the part of Medicare that covers prescriptions, and ask how the prescription itself will be covered before you fill it.
In my opinion, a pain clinic is not the best place to get Suboxone.
When you do find a doctor who prescribes Suboxone, ask whether the office is a pain clinic. I recommend against going to a pain clinic for Suboxone. You may find yourself in a waiting room with patients who are waiting for the same opioid prescriptions that you are trying to leave behind.
That is my opinion, and it is not a rule. There are pain clinic doctors who prescribe buprenorphine well, and you are the one who decides where you are comfortable.
What should a good Suboxone doctor tell you about the first day?
With a standard start, you must be in withdrawal before the first dose. The Suboxone prescribing information says that the first dose “should be administered when objective signs of moderate opioid withdrawal appear.”
Buprenorphine holds on to the opioid receptor more tightly than other opioids do. If you start too soon, it pushes the other opioid off and takes its place with a weaker signal, and the result is a sudden sickness known as precipitated withdrawal.
Is precipitated withdrawal dangerous? Typically, it is not. It is very uncomfortable, it passes, and it does not mean that the treatment has failed. Of course, if you cannot keep fluids down, or something feels seriously wrong, call your doctor, and call 911 in an emergency.
Starting the medication is known as induction. Today, many patients complete it at home, as long as the doctor is available by phone. When fentanyl is involved, the wait can be longer and less predictable, so ask whether the doctor uses a low-dose start, and read about how long to wait before starting Suboxone.
A two-week detox is not the same as treatment.
There are detox facilities that use buprenorphine for one or two weeks, lowering the dose each day until it is gone. When you leave, you are off of opioids, and you are off of buprenorphine as well.
Do these fast detox programs work? In my experience, not very well. Relapse is all too common after discharge, and by then the tolerance that once protected the patient is gone. With fentanyl in the supply, a relapse can be an overdose.
Long-term maintenance is the better course, and it saves lives. The Suboxone label states that there is no maximum recommended duration of maintenance treatment, so ask any doctor you are considering whether you may stay on the medication for as long as it is helping. Ask, as well, what the plan is when life interrupts, for example when you need surgery while taking Suboxone.
Whether to taper someday, and when, is a decision for you and your doctor. It does not belong to an insurance company’s calendar.
Why is there naloxone in Suboxone, and should you keep Narcan at home?
The naloxone in Suboxone is there to discourage misuse of the medication by injection. When you let the film or tablet dissolve under your tongue as directed, the naloxone does almost nothing.
Naloxone by itself is a different matter. As a nasal spray, sold as Narcan, it can reverse an opioid overdose for long enough for help to arrive. The U.S. Food and Drug Administration (FDA) approved Narcan for over-the-counter sale in March of 2023, so you no longer need a prescription to buy it.
A good Suboxone doctor will recommend or prescribe naloxone when treatment starts. In fact, the medication’s own label tells doctors to strongly consider it. Keep it in the house, and show your family how to use Narcan.
If you think that someone is overdosing, call 911 right away, even if you have already given Narcan.
The law is no longer what stands between you and treatment.
For twenty years, the question was who was allowed. Now, nearly every prescriber is allowed, and the question is who is willing, who is reachable, and who will be straightforward with you about the cost.
You may have to make more than one phone call. Whatever you do, do not give up after the first office that says no.
You are a person with a medical condition, and you deserve a doctor who knows it.
How do I prescribe Suboxone in my own practice?
I provide buprenorphine treatment with Suboxone and its generics to new patients throughout Florida by telemedicine, with in-office visits available in Fort Lauderdale. Patients start at home with phone support, and when fentanyl is involved, I use a low-dose start when needed.
My practice is concierge rather than insurance-based, and every visit is with me. Visits are monthly, and weekly when needed, with text access between visits for urgent questions. Care continues at the patient’s pace, whether the goal is long-term maintenance or a gradual taper.
To ask about starting buprenorphine treatment, please reach me through the contact form.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
